8 Scientific American, March 2022
SCIENCE AGENDA
OPINION AND ANALYSIS FROM
SCIENTIFIC AMERICAN’S BOARD OF EDITORS
Illustration by Martin GeeAfter Omicron comes pi in the Greek alphabet. And then rho,
sigma, tau.... Before SARS-CoV-2 finishes its grand tour through
the Greek alphabet, the global public health establishment
should do what it should have done long before this coronavi-
rus emerged. It must put in place the basic health systems need-
ed to detect new outbreaks and deploy technologies that allow
for vaccines and medicines to be manufactured and adminis-
tered in low- and middle-income countries.
Because they have often refused to treat COVID as a common
threat that demands a unified response, policy makers have yet to
thwart the predations of a virus that, to channel the Greeks again,
affects all ( pan ) people ( demos ). This myopia means that these mis-
takes could be repeated when a new pandemic arrives.
The next time could be worse. The National Academy of Med-
icine predicted in November 2021 that a flu epidemic akin to the
one in 1918 and 1919 could prove more catastrophic than COVID-19.
The preconditions for such a disaster are in place. A warming plan-
et, mega cities, mass migration, intercontinental travel and habi-
tat loss are among the reasons that infectious diseases, like inten-
sifying typhoons and hurricanes, have become part of our lives.
Fast-tracked development of diagnostics, vaccines, monoclo-
nal antibodies and antiviral drugs marks an undisputed medical
triumph of the COVID era. Also notable, however, is the failure of
governments and international organizations to use our current
predicament to rectify glaring public health deficiencies.
The Global Health Security Index for 2021 rated the world’s
195 countries as “dangerously unprepared” to deal with future epi-
demic and pandemic threats. The average score for individual
countries came in at 38.9 out of 100, about the same as the 2019
rating—before the pandemic began. Many countries failed to grasp
that the pandemic presented an unparalleled opportunity to lay
the groundwork for coping with not only this public health crisis
but also future ones.
Readiness for a COVID-30 or a new pandemic flu strain—or,
for that matter, an out-of-control bioweapon—will require new
generations of surveillance tools, diagnostics and drugs, as well as,
say, a “universal” coronavirus vaccine that can counter any strain.
Having sufficient available vaccine formulations with long shelf
lives would also help alleviate the inequities that have accompa-
nied distribution of shots. Underscoring the absence of “global” in
“global public health,” Portugal had fully vaccinated 89 percent of
its population by mid-January but Mali only 2.8 percent.
The most pressing priority should be a return to basics, both
globally and locally. COVID has served as a painful demonstration
that public health is as essential to national security as a standing
army. And the cost of health security is minimal. In 2016 the Com-
mission on a Global Health Risk Framework for the Future esti-
mated that for 65 cents a year for every person on the planet, we
could upgrade national pandemic preparedness programs world-
wide. An investment of $4.5 billion—far less than the price of a sin-
gle new ballistic missile submarine—might prevent the global loss
of millions of lives and an economic hit in the trillions of dollars.
The basics entail not only building new systems to prepare for
pandemics but a major strengthening of institutions already in
place. Public health legal expert Lawrence O. Gostin notes in this
issue ( page 46 ) that the World Health Organization has a 2022–
2023 budget of $6.12 billion, which is less than those of some major
U.S. teaching hospitals. The WHO needs not just money but
reforms that give it the authority to better monitor and intervene
when new infectious diseases emerge. At the country level, the
most basic of basics consist of functioning national systems that
furnish medical care for all and financial help, as needed, for child
care, food and housing and other measures to waylay the poverty-
related chronic diseases capable of sending even a relatively young
adult onto a ventilator during a future pandemic.
After repeated outbreaks of horrific diseases such as SARS, Ebo-
la and Zika, perhaps this calamity will prove traumatic enough to
allow for a coherent remake of the current system. Deaths from
COVID worldwide by mid-January about equaled the population
of Norway—and the pandemic is still with us. Only when global
public health commands the attention of policy makers in the same
way as a new contract for nuclear submarines will Greek letters
return to their more familiar role in American life as naming con-
ventions for student groups on college campuses.JOIN THE CONVERSATION ONLINE
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the Next One
Contagions worse than COVID will prevail
if neglect of global public health continues
By the Editors